H1N1 virus appears to have ended in anti-climax

Officials relieved, but still cautious

March 07, 2010|By Meredith Cohn | meredith.cohn@baltsun.com

The nearly year-old H1N1 influenza pandemic that disproportionately affected children and mobilized millions to line up for vaccination seems to have finally abated, and officials estimate that it has killed fewer people than die even in a typical flu season.

Public health officials remain cautious and say another wave of this novel and unpredictable virus could surface before the season's typical end in May, or even after. They are still recommending vaccine for people who haven't received inoculations against the virus.

But for now, local and federal officials are relieved that swine flu hasn't been as devastating as feared. It even seems to have crowded out the seasonal flu virus, which has produced few illnesses this year.

"We didn't know how serious it would be, so we acted with abundance of caution," said Frances Phillips, Maryland's deputy secretary of public health services. "It's a relief that it has been a milder pandemic than in some worse-case scenarios."

Since swine flu's peak in October, related doctor visits and hospitalizations are down, as are deaths. The U.S. Centers for Disease Control and Prevention estimates around 11,700 people nationally have died of H1N1 flu or complications. There are no state-level CDC estimates, but Maryland health officials have logged 44 lab-confirmed H1N1 deaths. The number is probably much higher, but many cases of disease were not confirmed.

Only one swine flu-related death, a man in the Washington metro area, has been reported in Maryland since December.

Seasonal flu kills an average of about 36,000 people each year, including about 1,000 in Maryland, according to the CDC.

While deaths surely have been lower this year, children and younger adults have been unusually affected. Large numbers of seniors typically succumb to seasonal flu, but that group appears to have some immunity to H1N1 flu because of exposure to similar strains decades ago.

There were three deaths among children last cycle in Maryland from seasonal flu, but five confirmed H1N1 cases this season, making it a larger percentage of the deaths, Phillips said.

"Typically we close down monitoring May 1 and we don't have any expectation of doing that this year," she said.

Phillips said vaccine will likely be offered for months, perhaps even until the new seasonal vaccine becomes available next fall. Each vaccination builds some immunity going forward, she said.

And while two vaccinations were required for protection from H1N1 and seasonal flu this season, they will be combined next time. Federal officials recently said they would recommend every American get immunized, a change from the past when just vulnerable groups were advised to get vaccinated.

Officials do know that the H1N1 virus is not gone. The World Health Organization says it's still being seen in Eastern Europe and parts of Central Asia. The group is continuing to monitor the virus to see if it mutates into something more dangerous - so far, it has not.

In the United States, CDC officials can't say why the H1N1 flu appears to have peaked in late October and waned in recent months, or if there will be another wave in parts of the country not hard hit in the last two waves in the spring and fall.

"There are hypotheses, but no one truly knows the answers," said Tom Skinner, an agency spokesman.

And officials will continue to encourage vaccinations even though spring is near. Typically a third of Americans get immunized for seasonal flu every year, including large numbers of elderly. Officials believe than more than the average have gotten seasonal flu vaccine this year. A smaller number, about 85 million, have gotten the H1N1 vaccine so far, probably because it was not as available early on as manufacturers ramped up production to combat the unexpected virus.

The extraordinary effort of public health officials to vaccinate Americans, particularly children, is believed to have saved many lives, Skinner said.

"We won't be surprised if we see sporadic activity until spring and summer," he said.

Local health departments are continuing to hold H1N1 and seasonal flu clinics, though the lines that were a common sight last fall are gone. Adults who weren't in high priority groups, which included pregnant women, young children and health workers, are coming in now, as are parents with kids who need a second vaccination. Officials say children under 10 need a booster, no matter how much time has passed since the first dose.

Baltimore County will hold more clinics this month. Howard County has been offering a stream of no-appointment clinics at the health department, libraries, senior centers, restaurants and other sites, which have been attracting an average of 25 to 30 people a day. Whatever the reason for the decline of the disease, health care workers who had been inundated with patients are now breathing a collective sigh of relief. Private and emergency room doctors at the Greater Baltimore Medical Center, for example, are seeing vastly reduced numbers of sick people.

"Most influenza epidemics would be from January to March," said Dr. Tim Doran, chairman of pediatrics at the hospital and a practicing pediatrician. "So we are unusually inactive."